In his decision, O’Connor leaned heavily on the U.S. Supreme Court’s infamous 2013 Hobby Lobby decision, a ruling which itself leaned heavily on a 1993 law called the Religious Freedom Restoration Act, a law which basically says that the government can’t “substantially burden” an individual’s freedom of religion, especially if there’s a less burdensome way to do do things, say, by letting people refuse service to anyone they find religiously offensive.

The case that O’Connor ruled on pitted the Christian Medical & Dental Associations (CMDA) and the Franciscan Alliance (FA), two networks of religious hospitals and medical professionals, against the Department of Health and Human Services (DHHS). The DHHS interpreted President Obama’s Affordable Care Act as having a rule forbidding discrimination against people on the basis of “sex”, whether they’re male or female, cisgender or transgender.

However, the CMDA and FA (and ultimately, Judge O’Connor) disagreed, saying that requiring doctors to perform hormone therapy, hysterectomies and gender affirmation surgeries on trans people equals an infringement on their religious beliefs. The religious beliefs claim seems odd seeing as the Bible has no overt references to transgender people. Nevertheless, some Christians have interpreted various lines about men, women and same-sex intercourse to apply to trans folks.

O’Connor’s ruling in this case sets limited judicial precedent that could allow other medical providers a chance to refuse care based on their other religious beliefs. If a doctor disagreed with serving an LGBTQ person, seeing a child of same-sex parents (something that has happened, by the way) or considered a disease as a punishment from God, then they could potentially refuse care and be protected under this ruling.

It’s especially disturbing since President-Elect Trump has promised to sign the First Amendment Defense Act (FADA), a law allowing anyone to discriminate against LGBTQ people on the basis of religious freedom. Both FADA and O’Connor’s ruling may get overturned as unconstitutional in higher courts, but for the time being both could hurt a lot of LGBTQ people, trans and otherwise.